Resisting institutionalization: constructing old age and negotiating home.

INTRODUCTION

In this article I seek to contribute to critical gerontology by broadening the discussion of "place" and its inextricable link with the body. Following Agnew (1993), the concept of place is interwoven with three elements: locale, location, and a sense of place. Locale is the setting in which an activity and social interaction occur. Location is the social, economic, and political processes which affect locales. Sense of place is the subjective territorial meaning of a locale, or "structure of feeling". A key tenet of Agnew's definition of place is that it is not just a locale, a setting in which social relations are constituted, but also a source of emotional and experiential meaning for its inhabitants.

A growing body of research is focusing on important experiential dimensions of a home environment as they apply to the elderly. An important theme to emerge from this research is that place, construed as home, plays a critical role in maintaining a sense of personal identity (Rowles 1983, 1993; Rubinstein 1989). This is because home, unlike many other accommodation options available to frail older people, does not compromise their independence. Home is a place where control over one's own life can be freely exercised (Fogel 1992; Rutman and Freedman 1988). The home environment as both a physical entity and a meaningful context for everyday life has significant implications for how old age is experienced by its inhabitants.

In this article I explore the significance of home space for a group of senior tenants living in a supportive housing building. Drawing upon twelve months of anthropological field research conducted at Home Frontier(1) in 1995, I describe the nature and meaning of the linkages between the senior tenants and their living space.(2) "Locating" seniors within their living environment (house, apartment, seniors' residence) identifies physical, emotional and experiential realities which their home holds for them. Understanding how their lived environment is constructed and negotiated, and how it signifies meanings of home, enriches our understanding of the senior tenants for whom home is integral to a meaningful existence and their sense of independence. Home is an invaluable resource to senior tenants in adjusting to physical decline that comes with old age and in sustaining their independence and a sense of personal identity.

Rules and regulations which are enforced by the staff of Home Frontier are perceived by the tenants as features of institutional living. These constraints compromised the tenants' independence and effectively threatened their personal identities. Home Frontier became a struggle between a vision of home-as-place and place-as-institution. This is confirmed and dramatized by the tenants' relentless efforts to resist staff directives and to negotiate with staff their own terms of existence.

Home Frontier is more than a physical setting and a functional environment. It is a home setting that shapes and maintains personal identity by maximizing a sense of personal competence and control; it is also a "place" in that it is a shifting social space maintained through resistance" negotiations, and collective social life. Home Frontier is a home-place: both a space which facilitates independent daily living, and a local construction that is negotiated and contested in the practice of its use.

Localizing changes in personal capabilities and faculties which are inherent in the experience of growing old, captures what is all too often absent from gerontological and geriatric accounts of old age--the complex engagement between biological change, place, self-identity, and meaning. My argument is that culture(3) and place are important and valid indicators of the experience of old age, as are the biological and physiological changes which are an inherent part of the aging process. All aspects of the interaction between biology, culture and place are essential to the very constitution of old age as a human reality.

THE MEDICAL MODEL OF OLD AGE

In the nineteenth century, geriatrics and gerontology emerged as medical specializations in an era of Big Science (Achenbaum 1995). Important developments in the theory and practice of medicine had a significant effect upon the emergence of these medical specializations and the perception and treatment of the elderly (Haber 1983). Reflecting a preoccupation with scientific progress, researchers of old age endeavored to credentialize their field as a science (Katz 1996). Approaches generated by the micro-perspectives of biology, chemistry, immunology, and other "hard sciences" were embraced in order to achieve this endeavor. The meanings of old age were aligned to definitive physiological, pathological, and biological signs of senescence; the construction of old age derived from an analysis of bodily structure, process, and products. The terrain of these scientific researchers was restricted to what could be seen of old age in the body (Katz 1996).

With the biomedical model's focus on individual organic pathology and physiological etiologies, medicine became the pervasive force in the definition of and the approach to the aging process and the aged body (Estes and Binney 1989). The entire phenomenon of old age was brought within the domain and control of biomedicine because it was regarded as a process only of biological decline; as such, it was regarded as individual pathology (Robertson 1990). Medicine positioned the aged body in pathology thereby investing it with meanings linked only to disease and decline.

Geriatrics and gerontology "...arose in the wake of medicine's remaking the body into a precise field of signs whose referents were internalized, naturalized, and essentialized" (Katz 1996, p. 22). Medicine focuses on the anatomical body (Turner 1987; Katz 1996) engendering an act of closure and finitude, establishing cultural boundaries and securing biological norms. The body, with its physiological changes and organic functions, became the central focus for an understanding of old age. As geriatrics and gerontology developed, despite the diversity of interests among biologists, chemists, immunologists, and other researchers of old age, all assumed the biomedical model unquestioningly. It is the organizing principle of this model, which maintains a severance of biology from culture, and a decontextualization of the body, that is the focus of my critique.

GERONTOLOGY

As social scientists, gerontologists recognized that geriatricians' exclusive focus on physiological changes produced a limited social construction of old age. Gerontologists therefore sought ways to broaden their discourse. They distinguished their field from geriatrics by incorporating studies of sociology, psychology and demography (Katz 1996).

Despite their efforts to move beyond a strictly biological reading of old age, gerontologists retained many of the reductionistic tendencies characteristic of geriatrics and the biomedical model. Notwithstanding the considerable differences among conventional gerontological theories, all fall short of capturing a full contextual perspective of old age. In addition to abstracting sociocultural processes and variables from place, there is the common underlying presumption that such factors can be studied independently from biological processes. For example, in both disengagement theory and activity theory, the individual is the primary unit of focus. This inevitably renders both theories inattentive to structural or political factors. To transcend this limitation, age stratification theory, modernization theory and political economy theory focused on macro- structural relationships between the aged and capitalist society. However, in doing so, these theories tended not to consider cultural factors and individual intentionality.

All of these conventional theories seem to either focus exclusively on "...external influences affecting the observable behavior of the aged..." (Hazan 1994, p. 49) or make "...unsubstantiated inferences about the internal processes shaping the aged self" (Hazan 1994, pp. 49-50). In either case the body is accepted as a dichotomous, decontextualized form.

CRITICAL GERONTOLOGY

There is widespread unease in gerontology today that conventional styles of research and practice--the conventional positivism and empiricism prevalent in the field--are inadequate (Cole 1993). Sociological theories of old age have become exceedingly dynamic and comprehensive, and have taken a more critical turn. As Katz notes (1996, p. 4): "Critical gerontologists admonish gerontology for its narrow scientificity, advocate stronger ties to the humanities, endorse reflexive methodologies, historicize ideological attributes of old age, promote radical political engagement, and resignify the aging process as heterogeneous and indeterminate."

According to critical gerontologists the experience of old age in the scientific discourse is treated as part of the natural order to the exclusion of the cultural order (Dannefer 1989). This natural order produces an image of the individual as a passive being processed through an objectively factual …